Factors Affecting Longevity of Homograft Valves Used in Right Ventricular Outflow Tract Reconstruction for Congenital Heart Disease

Tweddell, James S.; Pelech, Andrew N.; Frommelt, Peter C.; Mussatto, Kathleen A.; Wyman, J. D.; Fedderly, Raymond T.; Berger, Stuart; Frommelt, Michele A.; Lewis, David A.; Friedberg, David Z.; Thomas, John P.; Sachdeva, Ramesh; Litwin, S. Bert

doi:10.1161/01.cir.102.suppl_3.iii-130

Cited by 160 publications

(155 citation statements)

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“…Our early mortality of 15% is similar to other reports of conduit placement in children 5,6 and we could not identify a homograft-related factor in the three patients who died. Mortality was more likely to be related to complexity of the procedures (unifocalization compared with the presence of a confluent pulmonary artery) or existing pulmonary hypertension.…”

Section: Discussionsupporting

confidence: 86%

“…1 -5 They have better haemostatic properties and are easier to implant than bioprosthetic conduits. 6 Fresh homografts stored at 4°C gradually lose their tissue integrity and must be discarded within 4 -6 weeks of collection. 1 The logistical problems caused by this time limitation have been greatly alleviated by cryopreservation, which theoretically extends their storage time indefinitely.…”

Section: Introductionmentioning

confidence: 99%

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Fresh Homografts Obtained through a National Organ-Sharing Programme for Repair of Congenital Heart Disease

Metin

Oto

et al. 2005

J Int Med Res

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Homografts have been used in congenital cardiac surgery for over 30 years. We utilized the resources of a national organsharing programme to obtain fresh homografts and report their use in correcting cardiac pathologies in 20 children between March 2001 and May 2003. In 16 patients, a valved conduit was used to form a connection between the pulmonary ventricle and the pulmonary artery. In three patients, a non-valved aortic conduit was used to form an extracardiac Fontan circulation and in one patient, non-valved pulmonary and aortic conduits were used to repair an infected aortic aneurysm. Three patients died following surgery. Survivors were followed up using echocardiography between 2 and 24 months post-surgery. Results demonstrate that, with the help of a national organ-sharing programme, the use of fresh homograft conduits is feasible in a paediatric patient population with reasonable waiting times.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Fresh Homografts Obtained through a National Organ-Sharing Programme for Repair of Congenital Heart Disease

Metin

Oto

et al. 2005

J Int Med Res

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“…Data from Tweddell et al (5) suggest that homograft replacement in a child who has had a previous RVOT reconstruction would likely be necessary 10 years after initial surgery. In their patient cohort, only one of 42 patients required surgery for replacement, 13 years postimplantation.…”

Section: Discussionmentioning

confidence: 99%

Long-term morphological changes in a cryopreserved pulmonary valve homograft

Luk

Butany

Erlich

et al. 2007

Canadian Journal of Cardiology

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T he first valved homograft was implanted by Ross and Somerville in 1966 (1), and since then, it has been the mainstay for right ventricular outflow tract (RVOT) reconstruction in cases of congenital anomalies and in the Ross procedure. In the latter case, the PH is inserted in the pulmonic position and the native pulmonary valve is used to replace the diseased aortic valve. Postoperatively, these patients have good to excellent long-term results; the patients are typically close to fullgrown adults at the time of the procedure (2). CASE PRESENTATIONA 25-year-old man was admitted for treatment of an aortic root aneurysm with severe aortic insufficiency after the Ross procedure 12 years earlier. The pulmonary homograft was stenotic. He was apparently asymptomatic, was not taking any medications and had recently quit smoking. Perioperative transesophageal echocardiography demonstrated a slightly dilated left ventricle with decreased systolic function (ejection fraction 35% to 45%), dilated aortic root measuring 6.3 cm in diameter and severe aortic regurgitation. There was moderate pulmonic stenosis, with a peak gradient of 10 mmHg and moderate pulmonic regurgitation. A patent foramen ovale was also found. The patient underwent an aortic valvesparing operation with preservation of the pulmonary autograft valve, replacement of the stenotic pulmonary homograft (PH) with another 30 mm PH and primary closure of the atrial septal defect. Nine days postoperatively, his two-dimensional echocardiogram showed trace aortic regurgitation and a normally functioning PH. He was discharged home 13 days later and returned to his native country, Italy. PATHOLOGYThe excised PH conduit had a length of 5.7 cm and a maximum outer diameter of 3.6 cm. The pulmonary artery (PA) wall thickness ranged from 0.5 mm to 1.0 mm, with few visible adhesions. All three homograft cusps showed structural changes, with significant loss of cuspal tissue. Only one cusp appeared relatively intact, but it was short (0.5 mm) compared with the normal length of 1.5 cm to 1.6 cm. The second cusp was largely absent and the residual tissue showed pannus originating from the suture line and apparent loss at the distal end. The third cusp was only partially seen; the rest of it appeared to have been lost and torn, and had prolapsed ( Figure 1A). The base of this cusp showed significant fibrosis and calcification. The PA showed aneurysmal dilation ( Figure 1B), with a circumference of over 7.5 cm. Histologically, the RVOT tissues, cusps and the PA showed pannus that covered the flow and nonflow surfaces of the cusps. There was no recognizable RVOT myocardium, and this subvalvular region showed fibrosis and elastosis. The cusps showed tissue degeneration and tears. In addition, the bases of the cusps showed calcification, cartilaginous metaplasia and areas of ossification with marrow spaces (Figures 2A and 2B). The graft PA showed thinning of its wall, total loss of the native smooth muscle cells, increased fibrosis and some 'collapse' of elastic plates, as well ...

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“…truncus arteriosus, tetralogy of Fallot, double-outlet RV and pulmonary stenosis, d-transposition of the great arteries with ventricular septal defect and pulmonary stenosis) (1). Despite some limitations, homografts remain a widely used option to restore the continuity of the RVOT (2)(3)(4). Mismatch between demand and supply for homografts makes their availability a limiting factor, in particular when small sizes are considered.…”

mentioning

confidence: 99%

“…Mismatch between demand and supply for homografts makes their availability a limiting factor, in particular when small sizes are considered. Moreover, small homografts used in neonates and infants require frequent replacement (3,(5)(6)(7). Over the past four decades, a large number of valved xenografts, classified according to the type of valve incorporated and the structure supporting this valve, have been developed and implanted in the pulmonary position (8 -14).…”

mentioning

confidence: 99%

Expandable Right Ventricular-to-Pulmonary Artery Conduit: An Animal Study

Boudjemline¹,

Laborde

Pineau

et al. 2006

Pediatr Res

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ABSTRACT:This study was performed to assess a new vascular stent graft as an expandable valved conduit for right ventricular outflow tract (RVOT) reconstruction in sheep. Conduits were constructed by sewing an 18-mm valved conduit inside a stent. Crimped to 16 mm, they were implanted either under or without extracorporeal circulation in seven (group A) and in five (group B) sheep, respectively. Six weeks and 3 mo after their insertion, conduits were dilated intraluminally. A valved stent was implanted percutaneously into conduits before they were killed. Two animals from group A recovered normally, whereas five animals had a complicated postoperative course. In group B, one died acutely due to kinking of the conduit. Balloon dilatations were performed in all surviving animals. First dilatations had a slight impact on valvular function in all animals but one, whereas second dilatations led to significant PR in all. Transcatheter valve implantation was performed successfully. When animals were killed, no bleeding was found around the surgically implanted device. In conclusion, we designed a biologic valved conduit for RVOT reconstruction that can be dilated sequentially to follow animal growth. This new device can have tremendous applications in children with congenital heart diseases involving the RVOT. (Pediatr Res 59: 773-777, 2006)

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Factors Affecting Longevity of Homograft Valves Used in Right Ventricular Outflow Tract Reconstruction for Congenital Heart Disease

Cited by 160 publications

References 14 publications

Fresh Homografts Obtained through a National Organ-Sharing Programme for Repair of Congenital Heart Disease

Fresh Homografts Obtained through a National Organ-Sharing Programme for Repair of Congenital Heart Disease

Long-term morphological changes in a cryopreserved pulmonary valve homograft

Expandable Right Ventricular-to-Pulmonary Artery Conduit: An Animal Study

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